Tuesday, December 20, 2011

My first choice would be to walk or run uphill, and ensure your heel touches the ground at each step. This is what I've used for Achilles' tendon issues in my bad leg. (My bad leg is now my good leg, at least for the time being.)

If you can't for whatever reason do that, an eccentric heel drop is the exact same movement.

"Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy."

The videos look useful, and are based on Alfredson's protocol. I'd skip the marshmallow shoes shown in the video, and do them barefoot. I'd also avoid orthotics... But that's just me. (I'd also avoid taking any medical advice from any doctor from Latrobe University, where this study is being conducted, as the quack Dr. Payne is a professor of podiatry there. I'll not link to Dr. Payne's site again, but you can find it at the bottom of that link.)

I'll also note that Dr. Alfredson says that the bent-knee heel drops are crucial. Did I mention that you should listen to his podcast before trying out these exercises?

One more observation: I'm not a doctor, or a physical therapist, just a foot-deformed westerner trying to run the way I was born to. Also, you should never believe anything you read on the internet, it's all crap.

Monday, December 19, 2011

Darya Pino reviews Joel Salatin's book. Salatin, if you're not familiar with him, is the man who just might save the world.

If we listen to him.

"...Joel is a thinker, and just a few pages into the book it is clear that he has a more intimate understanding of these topics than most experts and advocates could even dream of. Folks, This Ain’t Normal is by far the best ecology lesson I’ve ever had, and I try to be a responsible person and keep up on sustainable food issues. While most people discuss this subject academically, Joel actually knows how an ecosystem works, because he works with one every day back at Polyface Farm. For example, despite the cries of some environmentalists to do away with cows and replace them with tofu (aka soy beans), Joel explains in detail while a tillage-based crop like soy depletes soil, while a grass-based system of herbivore feeding builds and protects soil, and is necessary for environmental sustainability.

Food politics is another topic where Joel’s position runs flatly against conventional wisdom. Most of us in the food movement agree that Monsanto is the devil, and Joel is no different. But while most foodists lean liberal and think more regulation is the answer, Joel explains why those very regulations are what protect the big companies and put small farms like his out of business (exactly what Monsanto wants). So contrary to what you might guess, his position on this topic is strictly laissez faire...."

Friday, December 16, 2011

"Team Impossible Productions is developing an online series and television show that will follow a lucky group of 6 along their own Born to Run [BTR] experience with BTR coach Eric Orton. We're taking an incredible physical, mental, and emotional journey to achieve The Cool Impossible... and YOU could be part of it all."

"...Not surprisingly, in July 2011 an influential Harvard Medical School faculty, famous for his research and teaching about the diagnosis and treatment of Bipolar Disorder in children, was sanctioned by Harvard for not disclosing over a million dollars in fees by the pharmaceutical companies. The same story is unfortunately familiar to us in many different industries today. Powerful corporations motivated by profit, manipulate the consensus reality, and disseminate disinformation that has nothing to do with science or public health...."

Cutely politically-correct diagnosis. But the problem here is not with the "powerful corporations motivated by profit", it's with Harvard; which sanctioned, rather than fired, faculty members who violated their trust. Harvard's a non-profit, but that doesn't mean they're saintly. Unfortunately this sort of slack-minded thinking of attributing all evil to "corporations" is all to common.

"...For more than a decade, Biederman and his colleagues aggressively promoted the diagnosis and use of antipsychotics to treat childhood bipolar disorder, a problem that once was largely believed to be confined to adults. But the docs maintained this was underdiagnosed in kids and the meds could be used for treatment, even though they had not been approved for most pediatric use at the time. Meanwhile, the relationships with drugmakers were never properly disclosed (back story).

"And for years, payments they received from drugmakers were not thoroughly reported to university officials. Yet, millions of dollars in NIH grants, which were administered by the hospital, were awarded to the docs at the same time they were receiving money from various drugmakers that make and sell antipsychotics and antidepressants. Which ones? Eli Lilly, Johnson & Johnson, Pfizer, GlaxoSmithKline and Bristol-Myers Squibb.

"At one point, Biederman pushed J&J to fund a research center at MassGen that would focus on the use of its Risperdal antipsychotic in children, well before the med was approved for pediatric use. He was then placed in charge of the institute and began a study of 40 children between 4 and 6 years old who were given Risperdal and Lilly’s Zyprexa, another antipsychotic. At the time, Harvard and MGH rules forbid researchers from running trials with drugmakers if they receive more than $10,000 from a company that makes the drug (back story)....

For this, he received a spanking:

"...In a mea culpa addressed to their colleagues, Joseph Biederman, Thomas Spencer and Timothy Wilens wrote that “we want to offer our sincere apologies to HMS and MGH communities…We always believed we were complying in good faith with the institutional polices and our mistakes were honest ones. We now recognize that we should have devoted more time and attention to the detailed requirements of these policies and to their underlying objectives.”

And what is their punishment? They must refrain from “all industry-sponsored outside activities” for one year; for two years after the ban ends, they must obtain permission from the med school and the hospital before engaging in any of these activities and they must report back afterward; they must undergo certain training and they face delays before being considered for promotion or advancement (you can read their letter here)...."

What's missing from this story? Any accusation that the "powerful corporations motivated by profit" did anything wrong. The doctors clearly did, and the University didn't exercise any oversight over its staff.

"Drug manufacturers are hardly the only ones to blame--American children are being victimized by a consortium of influential psychiatrists at prestigious academic institutions--a list of about 30 KOLs (key opinion leaders in psychiatry) is contained in one of the J&J Risperdal documents; psychiatry's professional associations lend their "authoritative" support to this crime--as do a bevy of industry-financed patient "advocacy" groups. As if that were not enough, government agencies that were established to protect the public health and the scientific process have also come under the influence of industry.

"These commercially-driven stakeholders are condemning children to a life of drug dependency and drug-induced disabling chronic physical and mental illnesses...."

Emphasis in the original.

Here's the cherry on top:

"...Dr. Biederman is the researcher whose 'science' the FDA said it was leaning upon when it decided that pediatric bipolar disorder was a valid diagnosis back in July...."

"J&J, which is America's second-biggest drug company, said that 'an individual state should not penalise a pharmaceutical company for using a Federal Drug Agency-approved package insert or decide for itself whether a company complies with FDA rules'".

Tuesday, December 13, 2011

File this under "Risk Averse, Irrational", or maybe "Scientists, Unable to Understand Cause and Effect":

"Persons, especially young children or immunocompromised persons, should be
discouraged from sharing their bed with their pets or regularly kissing their
pets…. Although uncommon with healthy pets, the risk for transmission of
zoonotic agents by close contact between pets and their owners through bed
sharing, kissing or licking is real and has even been documented for
life-threatening infections."

To justify this warning, they cite 12, one dozen, cases of people who got a horrible disease and had an animal that was infected with the same disease.

One example given is this:

"...A 48-year-old man with diabetes and his wife had recurrent MRSA infections.
Culture of nares samples from the family dog grew mupirocin-resistant MRSA that
had a PFGE chromosomal pattern identical to the MRSA isolated from the patient’s
nares and his wife’s wound. The couple reported that the dog routinely slept in
their bed and frequently licked their faces…."

Poor dog. It caught MRSA from licking its infected owners' faces. That's right. From the above paragraph it's impossible to determine who acquired MRSA from whom. It's exactly as likely that the dog got it from the people as the other way around. Who could tell? Were the people and the dog both tested prior to the licking to see who was MRSA-free? Unlikely. (Given that MRSA is commonly acquired by immune-compromised people who visit our lovely healthcare system, I'd say it's most likely that the dog caught it from the people.)

Another example:

"A 2008 matched case–control study surveyed 9 plague survivors, 12 household
members of these survivors, and 30 age- and neighborhood-matched controls about
household and individual exposures. Four (44%) survivors … reported sleeping in
the same bed with a pet dog …."

Some of those folks may have gotten plague from fleas they got from the dog, or may just as likely they and the dog got fleas from rodents in their house. That's the usual vector for getting plague. One imagines they weren't letting the rats sleep in their beds...

As far as the irrationally risk averse part goes, twelve bad outcomes out of the millions of folks who sleep with pets and don't get any horrible diseases yields incredibly low odds of something bad actually happening.

For the record: I grew up sleeping with a dog, and nothing bad ever happened to me. The dog, and us, did wind up with fleas for a spell. Not fun, but not the plague, either.

Now, in my tick-infested neighborhood the dog sleeps on the floor. We regularly find ticks on our floor: that's what you call a real risk.

So yes, you're better off not sleeping with your pet. But if you do, don't lose sleep over it.

Wednesday, December 7, 2011

"I do think the incidence of second met stress fractures probably has a lot to do with neglecting the hallux set. If the big toe is weak or underutilized, mechanical loading seems to shift to the outer toes. This is often seen as 'duck-walking' where people walk with their feet canted outwards; they're making up for lack of big-toe stability by spreading their feet."

"Applying this statistical method to the three groups revealed highly significant differences between [Shod Indian] and [Western] and most clearly, between [Barefoot Indian] and W. Western subjects displayed higher relative pressures in the heel and under the second to third metatarsal head, but lower relative pressures in the midfoot and the toe region (Figure 9)."

In figure 6 from that paper, you can clearly see the difference in where pressure is applied between barefoot and shod feet.

If you're not engaging your big toe (the highest pressure point in the bare foot), your body needs to bear that weight somewhere, so it goes on the next-best place, the second and third met heads.

There's the genesis of your second and third metatarsal stress fractures.

This is not good. See that bent big toe?

Why doesn't the big toe engage more? I tried this test on my thumb (the equivalent structure from the hand): straighten your thumb out to the side so you can effect maximum pressure when pushing, and push hard. Feels fine. (I wound up hurting my hand doing this next step: I don't suggest repeating.) Then try bending your thumb toward the other fingers and press. Much less pressure, and it hurts.
Since the big toe is bent, by your shoes, you can't engage the same pressure.

"...Clearly, fractures of the 2nd metatarsal are occurring in individuals
who give minimalist running a try (for example, check out this great
post by Joe Maller), but it’s also important to keep in mind that this is
the most common type of foot fracture in shod runners as well. The big question,
for which we don’t yet have an answer, is whether incidence is in fact higher
among minimalist runners...."

Sadly, we're missing an important bit of information here: the incidence of second (and third) metatarsal stress fractures among the habitually barefoot. A quick search of Google Scholar for the phrase "metatarsal stress fracture barefoot india" turns up nothing.

"...If the big toe is weak or underutilized, mechanical loading seems to shift to the outer toes. This is often seen as 'duck-walking' where people walk with their feet canted outwards; they're making up for lack of big-toe stability by spreading their feet."

The Pronation article includes the following image (included with explanatory caption):

Figure 1. Rearfoot eversion during the stance phase of running in an uninjured, recreational runner. (A) At heel-strike, the foot is in a neutral or slightly inverted position. (B) At mid-stance, the foot is in a position of maximum eversion

"Duck-walking" is known in scientific terms as "rearfoot eversion", as you can see. That picture looks very familiar to me: I run like the guy in B, although as I continue engaging my big toe, I look more and more like A.

And sure enough, from the Military Stress Fracture paper:

"During running, peak rearfoot eversion was found to occur significantly earlier for the stress fracture group than for their matched controls, suggesting an increase in time spent loading the forefoot. The peak applied resultant horizontal force during the braking phase was directed significantly more laterally for the stress fracture group. In addition, the peak magnitude of resultant horizontal force applied during the propulsion phase was significantly lower for the stress fracture subjects."

"...when baby first starts to walk, he stands with his feet pointed out in a fallen-arched manner in order to balance himself. For a toddler this is normal. When a
few months later, he acquires strength (if his feet and toes have not been
weakened and distorted by shoes), he will by himself abandon the fallen-arched
gait and stance."

Sadly, for Joe, myself, and the majority of the shod world, our feet never get the chance to develop normally. Our development is retarded by wearing shoes all the time; we never properly develop our hallux, or worse, it's deformed, as in the picture of Mark Cucuzzella's feet above; and we suffer the resultant injuries of metatarsal-cuboid joint pain and iliotibial band syndrome (my case) or stress fractures of the over-stressed second and third metatarsal bones (Joe's case).

And just to be clear: these are not injuries of barefoot-style running. These are injuries caused by the wearing of shoes.

Monday, December 5, 2011

No wonder the Romans got such a harsh reception in the British Isles. Would you want to share your nettle stew?

"There are even containers of food, including a bowl with a wooden spoon still wedged into the contents, now analysed as nettle stew, which may have been a favourite dish in 1000BC."

"Favourite" may be overstating it. If it had been a favourite, why not finish it?

"The scale, quality and condition of the objects, the largest bronze age collection ever found in one place in Britain, have astonished archaeologists – and barely a fraction of the site has been excavated."

Seems to me like the Trail is a pretty ideal cold-weather road shoe... I'm looking forward to Jason's review of the Road to explain to me why I'm wrong.

I'd also be interested in trying it on the super-technical trails here in CT once I get a pair. I've been using my Speeds, but I wouldn't mind something that's lighter but has a bit better traction than those. ;)

"...This may be the single biggest improvement I’ve ever seen in one generation of shoes. I get the feeling the design team realized they produced a turd, then redesigned the new Road based on the MT10. The sole has changed dramatically. The upper is even more radical. The shoe is lighter and more flexible. It’s zero-dropped (heel height is the same as the forefoot height.) It went from being the red-headed step-child of the minimalist shoe world to being a legitimate contender for one of the best minimalist road running shoes ever...."

Troublingly, two of the reviewers note a "crinkling" of the fabric over the toe of the Trail model, which turned into a pretty fatal flaw in the VivoBarefoot Evo shoe. Hopefully this is just a break-in issue, as the lightness of the Trail due to the laser-cut and welded upper makes it worth a little bit of hopefully blood-free break-in.

I'll be in line for a pair of the lime-green Trails when they're released. The Road model will likely become my daughters' new school sneakers.

"Hunter gatherer humans who first began to incorporate wild einkorn into their diet experienced a downtown in health, including more dental caries, bone diseases, and probably atherosclerosis and cancer. Likewise, modern hunter gatherer cultures who do not consume wheat are spared these conditions."

Oetzi the ice man (found frozen in a glacier), "had wheat and barley as major cereals in [his] intestines, together with some weed seeds..."

Therefore:

"'...Although the Iceman did not lose a single tooth until the his death at an age of about 40 years, he had an advanced abrasion of his teeth, profound carious lesions, and a moderate to severe periodontitis,' the researchers said."

The researchers conclude:

"'We already know that he was eating grains, such as einkorn or emmer. The contained carbohydrates clearly increased the risk of developing dental diseases,' Zink said."

This is mistaken. There are plenty of high-carbohydrate diets that will leave you with perfect teeth.
Dr. Weston Price visited Africa and surveyed the Kikuyu tribe:

"Their chief articles of diet are sweet potatoes, corn, beans, and some bananas,
millet, and Kafir corn, a variety of Indian millet."

They have the typical malnutrition of a high-carbohydrate diet, "The Kikuyus are not as tall as the Masai and physically they are much less
rugged." However, as Dr. Price observes:

"...instead of cereals- for example, bread, oatmeal, rice, and tapioca- an
increased allowance of potatoes and other vegetables, milk, fat, meat, and eggs
was given. The total sugar, jam, and syrup intake was the same as before.
Vitamin D was present in abundance in either cod-liver oil or irradiated
ergosterol, and in egg yolk, butter, milk, etc. The diet of these children was
thus rich in those factors, especially vitamin D and calcium, which experimental
evidence has shown to assist calcification, and was devoid of those factors-
namely, cereals- which interfere with the process."

Oetzi suggests that even a bit of wheat in the diet is going to be problematic.

Saturday, December 3, 2011

McArdle's disease is a condition in which the sufferers have glycogen in their muscles, but are unable to access it as a fuel source. Typically they wind up being sedentary (which just makes the condition worse), but there are training approaches that can develop their non-glycogen sources of energy, and allow them to exercise without needing glycogen. (This is a compensation strategy, unlike the gene-knockout mice which have no glycogen stores, the people with McArdles disease will always try to access the glycogen store that they can't get to.)
So how do they train a McArdle's sufferer to not need glycogen?

"By increasing the fat content of his diet to 80% with 14% protein (1 g/kg/d) to
totally 1.760 kcal, ketosis of 2-6 mmol/l 3-OH-butyrate was established. The
principal effects comprise absence of carbohydrate-based stimulation of insulin
secretion leading to activation of glycogen synthesis, and repletion of the
tricarboxylic cycle with acetyl-CoA from ketone bodies. With a continuous
one-year diet his exercise tolerance was 3- to 10-fold increased dependent of
the endurance level...."

And then there's this:

"McArdle’s patients easily become sedentary. This just serves to exacerbate
muscle breakdown and worsen muscular quality. But you don’t need glycogen to
exercise or build muscles. Simple running has proven very effective in one case report [7]. Running also
involves eccentric exercise which has a low energy cost for a given level of
muscle force."

Sadly:

"Although a ketogenic diet seems the natural choice for patients with McArdle’s,
there are no real good studies of the strategy. A few small studies have
examined high protein feeding with some very modest results [8], but high
protein seems a bit of, as fat and ketones can replace glycogen more easily than
proteins."

Of course, we know a high-fat diet will kill you. (I'm being sarcastic, btw.) Surplus protein in the diet is converted into glucose.

Seems like a Maffetone-style training program would be perfect for McArdle's sufferers. Maybe someday it will be tried... Maffetone, of course, is big on warming up:

"If you are one of the 1:100,000 who has McArdle’s, proper warm up is very important. Gradual warm up causes a gradual increase in fat metabolism which reduces the need for glycogen. This is also a tip to everyone on ketogenic diets who like to engage in vigorous exercise. Proper and gradually increasing warm up exercises makes sure as much fat as possible is ready for use. Patients with McArdle’s are known to experience a “second wind” which happens when alternative sources of energy are increasing in availability."

I've been involved in a lot of discussions concerning the Pose method of running lately. I think that Pose has a lot of value, but it also has a couple of issues. One of those issues is attempting to control what ought to be autonomic processes in running.

One thing I've learned while trying to improve as a runner is that some things are best left to your body, as your concious mind doesn't have a lot to add.

"...You are not consciously aware of the vast majority of your brain’s ongoing activities, nor would you want to be—it would interfere with the brain’s well-oiled processes. The best way to mess up your piano piece is to concentrate on your fingers; the best way to get out of breath is to think about your breathing; the best way to miss the golf ball is to analyze your swing. This wisdom is apparent even to children, and we find it immortalized in poems such as “The Puzzled Centipede”:

A centipede was happy quite,Until a frog in funSaid, “Pray tell which leg comes after which?”This raised her mind to such a pitch,She lay distracted in the ditchNot knowing how to run.

"The ability to remember motor acts like changing lanes is called procedural memory, and it is a type of implicit memory—meaning that your brain holds knowledge of something that your mind cannot explicitly access. Riding a bike, tying your shoes, typing on a keyboard, and steering your car into a parking space while speaking on your cell phone are examples of this. You execute these actions easily but without knowing the details of how you do it. You would be totally unable to describe the perfectly timed choreography with which your muscles contract and relax as you navigate around other people in a cafeteria while holding a tray, yet you have no trouble doing it. This is the gap between what your brain can do and what you can tap into consciously...."

Anyone who's learned a sport or a task well is perfectly familiar with this phenomenon. You know you've taught it to yourself when you stop thinking about it, and you haven't really learned it until you can do it unconciously.

Do read the whole thing; especially the section on chicken sexers, which (assuming the story's not apocryphal) is a pretty brilliant example of training one's brain to do something that the concious mind can't even understand, let alone control or describe.